“New Screening Guidelines Won’t Assure Fewer Mammograms”
This New York Times highlights how healthcare providers will not necessarily follow the new screening guidelines suggested for breast cancer detection. Recent research has found that annual mammograms for women over the age of 40 are not as beneficial as previously thought. As a result, the American Cancer Society has updated its recommendation, stating that women should not begin annual mammogram screening until age 45 through age 55; then, they should receive screening every other year until they are at an age expected to have less than 10 years of life left. The ACS also recommends eliminating clinical breast exams entirely. These recommendations are based off of several studies, including one that showed a higher proportion of breast cancer diagnosis occurs when women are premenopausal. However, after menopause this proportion significantly decreases. This explains the ACS recommendation for annual screening to stop after age 55 and occur biannually. Harm also results from false positive findings, which can result in a second exam, another screening, or a biopsy. A cohort study conducted in 2005 concluded that performing a clinical breast exam as well as a mammogram resulted in the detection of 0.4 extra cancers as well as 20.7 false positive tests per 1,000 women. This depicts that the cost of performing these extra tests outweighs the benefit. Another study showed that using biennial screening instead of annual screening in women 50 to 69 might result in 57,000 fewer false positives over all for every 100,000 women over 10 years.
Although these studies prove that the ACS recommendations are valid, changing current screening procedures will be difficult for several reasons. Physicians have been conditioned to approach breast cancer prevention aggressively and to be invasive. Studies show that once this happens it is hard for them to reverse course. Moreover, physicians tend to believe that providing more care protects them from lawsuits and malpractice. Lastly, financial incentives also play a role in unnecessary screening.
This article relates to the concept of overtreatment that we discussed in class. The biopsy and screening not only cause unnecessary risks, but also unnecessary money to be spent on screening that is not benefiting the patient. Consequently, one of the reason the new screening guidelines will not assure fewer mammograms is that physicians are driven by financial incentive to provide more mammograms to their patients in order to generate higher income. In turn, unnecessary mammograms can be justified by stating that more care protects the patient by ensuring that harmful results do not go undetected. This is the fundamental justification for overtreatment; being extra cautious when it comes to preventative treatment outweighs the risks associated with the additional unnecessary treatment. Although a significant amount of studies have been performed proving the ACS recommendation for less frequent mammograms is logical, several factors are at play making physicians hesitant to follow these guidelines. These factors include the fear of being sued for malpractice due to insufficient care and the advancing of the medical field toward a profit-driven consumerist business.
This first period of the semester has been very enlightening because it has opened my eyes to some of the inefficiencies in the American health care system. I had never previously thought of the healthcare system as a consumer market. That is, I had not realized the competition amongst providers, the business strategies in pricing insurance and services, and the consumer mentality of patients. This realization is tremendously useful in understanding how the system works. However, it has set the frame work for the rewarding knowledge that I have amassed. Continue reading “Reflection on Learning: Part 1”
Many patients are willing to go through with a surgery for the relief of anxiety over the medical issue they are facing. In his article “Overkill,” Gawande tells the story of a patient named Mrs. E who had an extremely small carcinoma on her thyroid that would not have been an issue if it hadn’t been found. For Mrs. E, the relief she obtained was worth the serious health risks of her surgery.Even though she had a “turtle”, she took her chances and went through with the surgery. From a financial standpoint, the surgery is viewed as wasteful and unnecessary. From a medical standpoint, it seems like an overreaction to a small and unthreatening problem. But from the patients standpoint, the surgery was worth the money and risks associated with it. Gawande even points out that after the surgery, Mrs. E came back and “thanked me profusely for relieving her anxiety.” On the other side of the coin, over-treatment can bring about more anxiety than there was to begin with. In the case of Bruce, a colleague of Gawande’s who experienced the negative repercussions of over treatment. When Bruce’s 82-year old father began having fainting episodes his doctors told him he had severe atherosclerotic blockages and recommended doing a three-vessel cardiac-bypass operation as soon as possible, followed, a week or two later, by surgery to open up one of his carotid arteries. However, this surgery posed serious risk factors, including stroke. Leaving the decision to his son, it was not until after that Bruce realized the mistake of agreeing to the surgery. The surgery was not meant to relieve the fainting episodes because the blockages weren’t the cause of these episodes. Bruce’s father had a stroke during the surgery, losing his ability to talk coherently, and was moved into a nursing home, where he died 9 months later. For the patient, or in this case the patients family, things would have been better without the surgery ever taking place. Bruce not only had to deal with the worry and anxiety caused by effects of this unnecessary surgery, but also the regret of agreeing to the surgery that ultimately accelerated his fathers death. In Mrs. E’s case, the benefit of expelling her anxiety did outweigh the risks associated with her surgery. For Bruce, the opposite was true. So the truth is, although over-treatment is wasteful and unnecessary, in some cases it can can relieve anxiety and worry for the patient and in others it can bring about more.
In chapter nine, Weitz writes about an important factor when considering the US healthcare system: comprehensive benefits. How should an insurance company or an employer determine what ought to be considered a comprehensive benefit so that a particular group is not advantaged over another group?